Foreign Body Injury: Objects Stuck in the Skin and Soft Tissue

First aid: what to do now

Small, shallow objects (splinters, thorns, small glass slivers)

1. Wash your hands and the area with soap and water.
2. Look under good light, with a magnifying glass if needed.
3. If the end sticks out, grasp it with clean tweezers and pull it out at the same angle it went in.
4. If it is just under the surface, gently lift the skin over it with a needle cleaned with rubbing alcohol, then use tweezers.
5. Squeeze gently to make it bleed a little, wash again and cover with a bandage.
6. Do not dig deeply. If you cannot get it out in a few attempts, see a clinician.

Soaking the area in warm water for 10 minutes first softens the skin. Tiny fiberglass or cactus spines can sometimes be lifted with adhesive tape.

Large or deeply embedded objects

• Do not pull it out. The object may be blocking bleeding from a damaged vessel.
• Pad around it with clean cloth and secure it so it cannot move.
• Apply pressure around, not on, the object if it is bleeding.
• Keep the person still and call 911 or your local emergency number.

Fishhooks

A hook stuck only past the point, without the barb under the skin, can be backed out. A hook with the barb embedded is best removed by a clinician, who can use the string-yank, advance-and-cut, or needle-cover technique after numbing the area. Never try to remove a hook near or in the eye.

Why foreign bodies need attention

The body treats any retained object as an invader. Clues that something is still inside include:

• a sharp, localized pain when you press or move
• a feeling that "something is there"
• a small hard lump
• redness, swelling and pus around the site
• a wound that keeps opening or draining

Organic material (wood, thorns, spines) is most likely to cause infection and strong inflammation. Glass and metal are often better tolerated but can cut nerves and tendons or migrate. Pieces left behind are a common reason a wound fails to heal or becomes infected weeks later.

Common types and where they happen

A puncture wound through the sole of a shoe deserves extra care, because shoe material can be carried deep and lead to bone or joint infection.

How doctors find and remove foreign bodies

The clinician will ask what the object was, how the injury happened and whether you have had a tetanus shot, then examine sensation, movement and circulation beyond the wound.

• X-ray shows metal, most glass and stone.
• Ultrasound finds wood, plastic and thorns, which do not show on X-ray.
• CT or MRI is used occasionally for deep or complex cases (MRI is never used if metal may be present).

Removal usually involves a local anesthetic, a small cut to widen the opening, and careful exploration. Some objects that are deep, inert and causing no symptoms, such as tiny glass fragments or old pellets, are safer left in place than chased. Deep objects near nerves, tendons or joints may need a hand or orthopedic surgeon.

After removal: wound care and preventing infection

• Keep the wound clean and covered for a few days. Wash gently with soap and water daily.
• Watch for infection over the next week (see triage above).
• Tetanus: you need a booster if your last dose was more than 10 years ago, or more than 5 years ago for dirty or deep wounds. People who never completed the primary series may also need tetanus immune globulin.
• Antibiotics are not needed for most clean injuries. They are used for infected wounds, deep foot punctures through a shoe, animal or plant material in deep wounds, and people with diabetes or weak immunity.
• Pain relief with acetaminophen (paracetamol) or ibuprofen, following the label dose.

Complications

• Wound infection and cellulitis
• Abscess or chronic draining sinus
• Foreign body granuloma: a firm lump of scar-like tissue around retained material
• Tendon or nerve injury, especially in the hand
• Tetanus, rare in vaccinated people but serious
• Bone or joint infection after deep foot punctures

Objects in the eye, ear, nose, throat or airway are covered in our guide to foreign bodies. A scratch to the clear front of the eye is a corneal abrasion.

Prevention

• Wear gloves for gardening and woodwork, and safety glasses for grinding, hammering, mowing and drilling.
• Wear shoes outdoors and clean up broken glass with a damp paper towel after sweeping.
• Keep tetanus vaccination up to date with a booster every 10 years.

Frequently asked questions

Will a splinter come out on its own?

Small, shallow splinters often work their way out as the skin sheds, sometimes helped by a small pocket of pus. Deeper or wooden splinters tend to cause inflammation and infection instead. If a splinter is painful, red or not visible enough to remove, have a clinician take it out.

How do I know if glass is still in my skin?

Ongoing sharp pain when you press on or move the area, a feeling of something scratching inside, or a wound that will not heal suggest glass remains. Most glass shows on X-ray, so see a clinician if you have any doubt, especially after a hand or foot injury.

Should I pull out an object that is stuck deep in the body?

No. A deeply embedded or impaled object may be plugging a blood vessel, and removing it can cause severe bleeding or more damage. Keep it still, pad around it, apply pressure around the wound if it bleeds, and call 911 or your local emergency number.

Do I need a tetanus shot for a splinter?

Usually not if you are fully vaccinated and had a booster within 10 years. For dirty, deep or soil-contaminated wounds, a booster is advised if the last one was more than 5 years ago. If you are unsure of your vaccination history, ask a clinician.

Can a foreign body stay in your body forever?

Some can. Small, inert objects such as tiny glass or metal fragments sometimes stay for years without problems, and surgeons may leave them if removal would cause more harm. Organic material like wood or thorns usually causes inflammation or infection and should be removed.